Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Officials took a conservative approach in scoring the nation’s nearly 4,500 hospitals. Almost all performed at the national average when it came to their patient mortality rates.

However, for heart failure, 38 hospitals were listed as performing better than the national rate for heart failure, and 35 were listed as performing worse. For heart attacks, 17 performed better; 7 worse. The ratings are based on hospital claims data filed from July 2005 to June 2006.

Health and Human Services Secretary Mike Leavitt said that posting the hospitals’ performance meets the administration’s goal of helping consumers know what they’re getting for their health care money.

“People need to know not only what their health care costs, but how good it is,” Leavitt said.

At the same time, the ratings will also spur hospitals to take steps to improve their ratings.

“It really wasn’t an attempt to embarrass hospitals in any way, shape or form,” said Herb Kuhn, deputy administrator at the Centers for Medicare and Medicaid Services.

The rating took into account each hospital’s mortality rate, but it also incorporated other factors, primarily each hospital’s patient mix. For example, some hospitals see more elderly patients or more patients with diabetes than their competitors. So their rating takes that sicker patient mix into account.

Nationally, the 30-day death rate from heart attacks is about 18 percent. For heart failure, it’s about 11 percent.

Medicare officials said hospitals have already been notified of their ratings, and were given much more detailed information than what is being made available to the public. Quality improvement officials will work with the hospitals performing worse than the national average.

An earlier attempt some 20 years ago to measure hospital mortality rates foundered when hospitals questioned the methodology. It took many years for health care providers, consumer groups and government officials to agree on a set of measures that all could support.

Rich Umbdenstock, president and CEO of the American Hospital Association, said hospitals strongly back the government’s effort to give consumers information about the quality of care provided. Some of those hospitals that performed poorly with heart patients have had questions about the rating system.

“They are very grateful to have the information so they know what they need to focus on,” Umbdenstock said.